Centre for Liver Cancer, National Cancer Centre, Goyang-si, Gyeonggi-do, Republic of Korea.
Centre for Liver Cancer, National Cancer Centre, Goyang-si, Gyeonggi-do, Republic of Korea.
Clin Radiol. 2019 May;74(5):407.e19-407.e28. doi: 10.1016/j.crad.2019.01.024. Epub 2019 Mar 2.
To compare the therapeutic efficacy and safety of transarterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC) within the Milan criteria with or without the use of cone-beam computed tomography (CBCT).
Patients with HCC within the Milan criteria who underwent conventional angiography-guided TACE (Angio-TACE group: 58 patients from January 2010 to December 2011) were compared with those who underwent CBCT-guided TACE (CBCT-TACE group: 55 patients from January 2013 to December 2014). Local progression-free survival (LPFS), progression-free survival (PFS), and overall survival (OS) were compared. Adverse events after TACE were also investigated.
Baseline characteristics were balanced between the two groups. LPFS was significantly longer in the CBCT-TACE group than in the Angio-TACE group (median: not reached for 36 versus 19.2 months, respectively; Log-rank p=0.029). In multivariable Cox regression analysis, CBCT guidance had a significantly lower risk of local progression or death (adjusted hazard ratio: 0.585; 95% confidence interval, 0.344-0.995; p=0.048); however, there was no significant difference in PFS (3-year PFS: 15.9% versus 26.8%, respectively; p=0.122) or OS (3-year OS: 85% versus 88.2%, respectively; p=0.761) between the Angio-TACE and CBCT-TACE groups. Post-embolisation syndrome occurred significantly less frequently in the CBCT-TACE group (p=0.002).
CBCT-guided TACE could improve local tumour control for HCC within Milan criteria and showed fewer cases of post-embolisation syndrome.
比较米兰标准范围内经动脉化疗栓塞术（TACE）联合与不联合锥形束 CT（CBCT）治疗肝细胞癌（HCC）的疗效和安全性。
回顾性分析 2010 年 1 月至 2011 年 12 月行常规血管造影引导 TACE（Angio-TACE 组：58 例）和 2013 年 1 月至 2014 年 12 月行 CBCT 引导 TACE（CBCT-TACE 组：55 例）的 HCC 患者。比较两组患者的局部无进展生存期（LPFS）、无进展生存期（PFS）和总生存期（OS）。还比较了 TACE 后的不良反应。
两组患者的基线特征无显著差异。CBCT-TACE 组 LPFS 明显长于 Angio-TACE 组（中位：未达到 36 个月与 19.2 个月，Log-rank p=0.029）。多变量 Cox 回归分析显示，CBCT 引导 TACE 局部进展或死亡的风险显著降低（调整风险比：0.585；95%置信区间，0.344-0.995；p=0.048）；然而，两组患者的 PFS（3 年 PFS：分别为 15.9%和 26.8%，p=0.122）和 OS（3 年 OS：分别为 85%和 88.2%，p=0.761）无显著差异。CBCT-TACE 组栓塞后综合征发生率显著低于 Angio-TACE 组（p=0.002）。
CBCT 引导 TACE 可提高米兰标准范围内 HCC 的局部肿瘤控制率，并减少栓塞后综合征的发生。
